The Telegraph
Since 1st March, 1999
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Some of the most visible success stories in economic growth and globalization have been less successful in reducing child mortality. China and, to a more modest degree, India are in the front rank of high-growth, globalizing countries. Yet the annual progress in cutting child deaths has slowed in both countries since 1990... The case of China demonstrates that even the most spectacular economic growth rates and rising living standards do not translate automatically into more rapid decline in the child mortality rate. Per capita income growth increased from 8.1 per cent in the Eighties to 8.5 per cent in 1990-2003, maintaining a spectacular advance in poverty reduction. Indeed, China has already achieved the millennium development goals target of halving income poverty from 1990 levels. However... the annual rate of decline in the incidence of child mortality fell from 2.3 per cent in the Eighties to 1.9 per cent in 1990-2003...The slowdown has prompted questions about whether China, despite a strong track record in a wide range of human development indicators, will meet the MDG target of reducing child mortality by two-thirds by 2015.

At a far higher level of child mortality than China, India seems to be headed in a similar direction. More rapid growth may have put the country on track for the MDG target of halving poverty, but India is widely off track of the child mortality target. The annual rate of decline in child mortality fell from 2.9 per cent in the Eighties to 2.3 per cent since 1990 ' a slowdown of almost one-fifth. As in China, the slowdown has occurred during a period of accelerating economic growth. Developments in India and China have global implications. India alone accounts for 2.5 million child deaths annually, one in five of the world total. China accounts for another 730,000 ' more than any other country except India.

Why has the rate of progress slowed' One view is that a slowdown in the rate of decline in child mortality is inevitable. Expanding public health provision through immunization programmes and other services can yield big public health gains, especially in reductions from high levels of mortality. Once these 'low hanging fruits' have been collected, so the argument runs, the problem becomes more concentrated in populations that are harder to reach, more vulnerable and less accessible to public policy interventions, driving up the marginal costs of saving lives and dampening progress.

Applied in the current context, the low hanging fruit argument lacks credibility. Some countries 'Malaysia is an example 'have accelerated the rate of reduction in child mortality from already relatively low levels. Others have sustained rapid progress over time, even during periods of low growth. In 1980, Egypt had a higher child mortality rate than Ethiopia does today. At its current rate of progress it will reach Sweden's level by 2010...

Low income is not a barrier to progress. Vietnam and Bangladesh have both accelerated the pace of child mortality rate reduction. Indeed, at a lower level of income and a comparable rate of economic growth, Vietnam has now over-taken China on improvement in child mortality. Similarly, at a lower level of income and with far lower growth, Bangladesh has overtaken India. these differences matter. Had India matched Bangladesh's rate of reduction in child mortality over the past decade, 732,000 fewer children would die this year. Had China matched Viet Nam's, 276,000 lives could be saved. Clearly, there is still a huge scope for rapid reductions in child death...

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